New Study Shows Dental Appliance Successful in Treating Patients with Severe Sleep Apnea

The University of Texas Health Science Center at San Antonio
Monday, February 23, 2009

SAN ANTONIO (Jan. 14, 2009) - Imagine choking and gasping for air every time you fall asleep. Between 18 million and 20 million people in the United States suffer from these frightening symptoms because of a common disorder called sleep apnea. Because of a lack of awareness among both health professionals and the public, up to 90 percent of sufferers aren't diagnosed or treated, and that could prove deadly.

When left untreated, sleep apnea may lead to more serious health problems. According to national health statistics, nearly 38,000 cardiovascular deaths annually are in some way related to sleep apnea.

Although treatment is available, many don't comply with standard therapies. Researchers in the Dental School at The University of Texas Health Science Center at San Antonio are offering another treatment option that is more appealing, more affordable and easier to use than standard therapies.

Paul McLornan, B.D.S., assistant professor in the Department of Prosthodontics, is the lead investigator of an 18-month study involving sleep apnea patients at the South Texas Veterans Health Care System, Audie Murphy Division. Researchers used an oral appliance called the Thornton Adjustable Positioner (TAP) to treat those suffering from moderate to severe sleep apnea.

"What we found was that many of our patients with moderate to severe sleep apnea were not adhering to standard treatment with a Continuous Positive Airway Pressure (CPAP) machine," Dr. McLornan said. Although the CPAP is considered to be the gold standard in treating sleep apnea and is very effective, Dr. McLornan said compliance by patients is well below 50 percent.

"Some patients say the machine (which uses a face mask connected to tubes and blows air down a patient's throat during sleep to keep the airway open), is cumbersome or noisy," Dr. McLornan said. "Some said it was uncomfortable or that it bothered their spouses, or that they were just too embarrassed to use the machine."

Dr. McLornan's study proved that the TAP device, which is much smaller and fits in a patient's mouth, is now an option for patients with severe sleep apnea.

"It was previously thought that treatment for patients suffering from severe sleep apnea was limited to use of the CPAP or surgery," Dr. McLornan said. "Our study added to the body of medical and dental research literature by showing that oral appliances can be effective in treating people with severe sleep apnea. As an added advantage, the device is less cumbersome, is better tolerated by patients, and is much less invasive and costly than the CPAP or surgery."

Patients in the study were fitted with the TAP appliance and given a tiny key that fits in the front of the device. The patient was instructed to wear the appliance every night and to insert and turn the key several millimeters before bedtime. By turning the key, the patient pulls his lower jaw forward, thus creating an open airway in the throat.

"We asked the patients to tell us when they reached a point in the adjustments that felt comfortable and when they felt they were able to sleep without snoring or gasping," he said. "We then evaluated patients using standard sleep studies to determine whether or not their sleep had indeed improved."

Dr. McLornan said patients in his study improved significantly using the TAP. "We saw patients who began the study with severe sleep apnea end the study with very mild or no sleep apnea. They reported sleeping better, feeling more rested in the morning and altogether healthier."

Dr. McLornan said this research is vital to both the medical and dental communities.

"Sleep apnea is a growing and serious problem for people of all ages and all ethnic groups," Dr. McLornan said. "If left untreated, it becomes progressively worse. People suffering from sleep apnea are at increased risk for high blood pressure, heart attacks, strokes, obesity and diabetes. It takes both dentists and medical professionals working together to control this potentially deadly disorder. The TAP gives patients another viable treatment alternative."

Dr. McLornan said patients who think they may suffer from sleep apnea should consult their family physician and undergo a standard sleep study in a lab. Costs are normally covered by medical insurance.

The American Academy of Sleep Medicine, the professional society that sets the standards for and promotes excellence in sleep medicine, now recommends that oral appliances can be the first line of treatment for people with mild to moderate sleep apnea. Dr. McLornan's study demonstrates it can be used for patients with severe problems as well.

Print contact: Natalie Gutierrez, (210) 567-6814, gutierrezn@uthscsa.edu or Will Sansom, (210) 567-2579, sansom@uthscsa.edu.
Broadcast contact: Lucie Portela, (210) 567-2570, portelal@uthscsa.edu.


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